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George R.B.,5850 5980 University Avenue | McKeen D.,5850 5980 University Avenue | Chaplin A.C.,Dalhousie University | McLeod L.,Health Center
Canadian Journal of Anesthesia | Year: 2010

Introduction: Use of the lowest effective dose of oxytocin may reduce side effects. This study was designed to determine the effective dose (ED) 90 of oxytocin infusion for an elective Cesarean delivery (CD) to prevent uterine atony. Methods: The participants were ASA I and II, non-obese, non-labouring adult women undergoing an elective CD at term with a singleton gestation. The spinal anesthetic technique was standardized, and a blinded infusion of oxytocin was administered after delivery. The obstetrician rated the uterine contraction as either satisfactory or unsatisfactory. The initial dose of oxytocin infusion was 0.4 IU•min-1, and the dose for the next subject was based on the response of the preceding subject as per a biased-coin design up-down sequential method. The ED90 was calculated using Firth's penalized likelihood estimation. Results: Fifty subjects were screened, eight subjects were excluded, and two patients were withdrawn. Seven of the 40 subjects had uterine tone that was judged unsatisfactory by the obstetrician and required additional uterotonic medications. The ED90, i.e., the dose at which 90% of women were judged to have satisfactory uterine tone, was 0.29 IU•min-1 (95% confidence interval [CI] 0.15-0.43 IU•min-1). Discussion: In this study, we found the ED 90 of oxytocin required to prevent uterine atony and postpartum hemorrhage after an elective CD to be 0.29 IU•min-1- approximately 15 IU of oxytocin in 1 L of intravenous fluid administered over a one-hour period-(95% CI 0.15-0.43 IU•min-1). This oxytocin infusion dose is 30% less than the clinical infusions currently in use. It remains to be seen whether this dosing will be required for higher risk individuals or for labouring parturients undergoing non-elective CD. (Clinical Trial gov. NCT00785395). © 2010 Canadian Anesthesiologists' Society.

Bernstein M.L.,5850 5980 University Avenue | Bernstein M.L.,Dalhousie University
Cancer | Year: 2011

Cancers in children and adolescents are fortunately infrequent. Overall, cure rates are good, approximately 80%, although this varies by histology and stage. Targeted therapies aim to improve efficacy and decrease toxicity by more specifically affecting malignant cells or their supporting stroma. Cancers of early life are often of different histology than those seen in adults. Sometimes, the same pathway is affected, even if the histology is different. Toxicities may also be different, particularly in younger children. These factors render drug development in young people challenging. This article reviews some successes and challenges to that development, including brief discussions of imatinib, lestaurtinib, antiangiogenesis, and anti-GD2 therapies. Copyright © 2011 American Cancer Society.

Siddiq I.,Dalhousie University | Hughes D.,5850 5980 University Avenue
Canadian Respiratory Journal | Year: 2012

Yellow nail syndrome is a rare disease and reported mainly in adults. A case of yellow nail syndrome involving an eight-year-old girl with associated discoloured yellowish nails on the fingers and toes, lymphedema and chronic cough, and sputum production is reported. ©2012 Pulsus Group Inc. All rights reserved.

The survival outcome of childhood cancers in developing nations has failed to keep pace with that of developed nations. Technological advances offer a unique and radical opportunity to develop programs and strategies to improve outcomes of childhood cancer globally. The novel field of 'techno-oncology' has a broad scope and the potential to phenomenally impact, revamp and model the care of pediatric cancer patients in the developing world. Many frontiers and opportunities in the area remain to be explored as well as many challenges to be surmounted. © 2015 Informa UK, Ltd.

Flanagan H.E.,York University | Flanagan H.E.,5850 5980 University Avenue | Perry A.,York University | Freeman N.L.,Surrey Place Center
Research in Autism Spectrum Disorders | Year: 2012

File review data were used to explore the impact of a large-scale publicly funded Intensive Behavioral Intervention (IBI) program for young children with autism. Outcomes were compared for 61 children who received IBI and 61 individually matched children from a waitlist comparison group. In addition, predictors of better cognitive outcomes were explored (n = 142). Although random assignment did not take place, a standardized waitlist management system was used that did not include any prioritization other than time of referral. Groups did not differ significantly on available measures at intake. The treatment period tended to be longer than the waitlist period and this difference was controlled in analyses. At exit, the IBI group had better outcomes in all measured areas, with milder autism severity, higher adaptive functioning, and higher cognitive skills. Younger initial age predicted better cognitive outcomes in the IBI group but not the Waitlist group. Higher initial adaptive skills predicted better outcomes similarly in the two groups. Results support the effectiveness of community-based IBI and suggest that earlier age at treatment onset may increase the likelihood of better outcomes relative to comparison conditions. © 2011 Elsevier Ltd. All rights reserved.

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